Stomach popped out: Abdominal Bulging: Diastasis Recti or Hernia?

14.11.202215.07.2023 by alexxlab

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Abdominal Bulging: Diastasis Recti or Hernia?

The main way to tell if you have a hernia or diastasis recti is whether you feel pain. Hernias can cause substantial pain while diastasis recti may increase discomfort and abdominal wall weakness.

Let’s take a deeper look into the difference between diastasis recti and hernias.

Diastasis recti

Diastasis recti happens when the connective tissue between your rectus abdominis (six-pack) muscles is stretched, creating an abnormally wide distance between the muscles. This separation can present as a bulge, usually of the upper abdomen, that you may notice when you cough, sit up in bed or lift something heavy.

The most common causes of diastasis recti are pregnancy and obesity, but abdominal wall weakness and previous abdominal surgery can also increase a person’s risk. Diastasis can also be congenital or something that developed in the womb.

Typically, diastasis recti are oval-shaped bulges between the breastbone and belly button and are not painful. A person may notice it during activities that cause them to contract the abdomen.

Aside from the prominent bulge, abdominal wall weakness could make any type of weightlifting and core exercises more difficult.

A doctor may diagnose diastasis recti when they see a “classic bulge” present when the patient sits up. A CT scan showing a separation of ab muscles may also lead to a diagnosis.

Diastasis often does not require surgery. For pregnant people, the condition typically improves after childbirth.

Following diagnosis, prescribed treatment may involve physical therapy to strengthen the ab muscles or diet and exercise for weight loss purposes.

If abdominal wall weakness associated with the diastasis recti becomes problematic, an abdominal binder may help. There are many types of abdominal binders; however, the general concept is a compressive garment worn around the belly to provide additional support.

Hernias

A hernia is a hole in the tissues of the belly wall through which fat, fluid or an organ can stick out. Hernias can be located at or near the bellybutton, in the groin, or at a previous surgical incision. Some hernias are present at birth while others develop over time.

A hernia looks like a bulge or protrusion located somewhere on the abdomen or in the groin. You may notice the hernia when you cough, sneeze, lift a heavy item or during a bowel movement. The bulge can be visible during rest periods, as well.

Hernias will often cause pain at the site of the bulge.

A hernia can often be diagnosed during an exam; a doctor may be able to see or feel the hernia’s bulge or they will use a CT scan for a better look at the abdominal wall to determine if there is a hole.

Hernias can be repaired surgically, and the goal is to repair them before tissue or a stomach intestine pushes through the hole.

Abdominal binders are recommended for hernias, as well, to reduce symptoms.

If you would like a doctor to look at your abdominal bulge, call (713) 798-6363 to make an appointment at the Baylor Medicine Hernia Center.

By Heather West, PA-C, Specialty Abdominal Wall Surgery, Division of Trauma and Acute Care Surgery

Bulging Stomach When Sitting Up: Diastasis Recti Information and Exercises

NOTE: This article is over 3 years old and may not reflect current information, despite the page being updated. It may still be useful for research but should be verified for accuracy and relevance.

Published: 2014-03-27 | Updated: 2022-03-24
Author: Disabled World | Contact Details
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Perform a Quick Test for Diastasis

Lie on your back with knees bent, feet flat on the floor.
Place a hand behind your head for support.
Place the index and middle fingers of your other hand just above your belly button, pointing them downward.
Raise your head and neck off the floor and press your fingers into the separation between your muscles.
If you can fit more than two fingers into the opening, you likely have a diastasis.
Your doctor can diagnose this condition with a simple physical exam.

Diastasis Recti Repairs

Healing the connective tissue is all about putting it in a better (narrow) position, bringing blood flow to it and protecting it when doing any type of activities so it is not being stretched nor does it have any intra-abdominal force or pressure on it.

A study in 1988 was conducted to determine if exercises could reduce the amount of separation in the rectus abdominis muscles. After a six week trial, results were shown that exercising greatly reduced the amount of the distasis.

Exercises Shown to Reduce Distasis Recti Separation

Incorrect exercises, including crunches, can actually increase the distasis recti separation.

All corrective exercises should be in the form of pulling in of the abdominal muscles rather than a pushing of them outward.

Consultation of a professional physiotherapist is recommended for correct exercise routines.

Exercises for Females and Males with Diastasis Recti

Squat with squeeze: A variation to the “Squat against the wall” is to place a small resistance ball between the knees, and squeeze the ball as you lower your body to the seated position – 20 repetitions.
Seated squeeze: Again in a seated position, place one hand above the belly button, and the other below the belly button. With controlled breaths, with a mid-way starting point, pull the abdominals back toward the spine, hold for 2 seconds and return to the mid-way point – 100 repetitions.
Core contraction: In a seated position, place both hands on abdominal muscles. Take small controlled breaths. Slowly contract the abdominal muscles, pulling them straight back towards the spine. Hold the contraction for 30 seconds, while maintaining the controlled breathing – 10 repetitions.
Head lift: In a lying down position, knees bent at 90 degree angle, feet flat, slowly lift the head, chin toward your chest, (concentrate on isolation of the abdominals to prevent hip-flexors from being engaged), slowly contract abdominals toward floor, hold for two seconds, lower head to starting position for 2 seconds – 10 repetitions.
Upright push-up: A standup pushup against the wall, with feet together arms-length away from wall, place hands flat against the wall, contract abdominal muscles toward spine, lean body towards wall, with elbows bent downward close to body, pull abdominal muscles in further, with controlled breathing. Release muscles as you push back to starting position – 20 repetitions.
Squat against the wall: Also known as a seated squat, stand with back against the wall, feet out in front of body, slowly lower body to a seated position so knees are bent at a 90 degree angle, contracting abs toward spine as you raise body back to standing position. Optionally, this exercise can also be done using an exercise ball placed against the wall and your lower back – 20 Repetitions.
Lying on floor: Begin by lying down on the ground on your back with both legs bent and both feet flat on the floor. Tighten the muscles of your lower abdomen and lift your hips off the floor. Perform 10 repetitions.
Stomach press: This exercise is performed by lying down with both legs bent at about a 90 degree angle with the soles of both of your feet flat on the floor. Put both hands on your lower stomach around your belly button, and be sure that the fingers of both of your hands are pointing down toward your genitals. Breathe out and use a slow and controlled motion to lift your head and shoulders off the ground while pressing down on your lower abdomen with your hands and fingers.
Leg Extension: Lie down with both legs bent and both feet flat on the floor. Breathe in and slowly begin to exhale while simultaneously straightening one leg and sliding it down on the floor. Use the muscles of your lower abdomen to help stabilize your straightened leg. Extend your leg as far as possible without serious pain, then inhale and return to the starting position. Repeat using both legs.

Surgery

In extreme cases, diastasis recti can be corrected during a cosmetic surgery procedure known as an abdominoplasty by creating a plication or folding of the linea alba and suturing together. This creates a tighter abdominal wall.

The skin is lifted near the pubic hair, and elevated to the level of the breast bone. The muscles are tightened in the mid-line where the tissue had been stretched. Permanent stitches are often used. In the most severe cases, mesh is used to reinforce the central repair area.

Splints, Belly Binders and Abdominal Wraps

Postpartum abdominal binding has also been traditional practice in many parts of the world for generations. This is the process of wrapping or binding your mid-section to draw the split recti muscles back together. Belly binding may ‘hold you in’ and provide support to your lower back. But wearing a splint or binder won’t strengthen or tighten the muscles.

Quick Facts

Diastasis recti is a separation between the left and right side of the rectus abdominis muscle. This muscle covers the front surface of the belly area.
A diastasis recti looks like a ridge, which runs down the middle of the belly area. It stretches from the bottom of the breastbone to the belly button. It increases with muscle straining.
Diastasis recti is commonly seen in women who have multiple pregnancies, because the muscles have been stretched many times.
Pregnancy-related diastasis recti often lasts long after the woman gives birth. Exercise may help improve the condition. Umbilical hernia may occur in some cases. If pain is present, surgery may be needed.
In most cases, diastasis recti usually heals on its own.

(Engelhardt, Laura (1988). “Comparison of two abdominal exercises on the reduction of the diastasis recti abdominis of postpartum women”. ProQuest Dissertations and Theses. UMI Dissertations Publishing.)

Lipoma, or wen – causes, symptoms of the disease, diagnosis and treatment

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Tumor

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IMPORTANT!

The information in this section should not be used for self-diagnosis or self-treatment. In case of pain or other exacerbation of the disease, only the attending physician should prescribe diagnostic tests. For diagnosis and proper treatment, you should contact your doctor.

Lipoma: causes, symptoms, diagnosis and treatment.

Definition

Lipoma is a common tumor composed of fat cells (adipocytes) and is usually separated from surrounding tissues by a thin connective tissue capsule. Lipomas can form anywhere where fat cells are present, usually located subcutaneously, but are sometimes found on internal organs (for example, in the stomach, esophagus or intestines, bronchi, heart, or muscles).

Lipomas are benign neoplasms that do not tend to become malignant and do not cause discomfort to patients. The exception is those cases when lipomas are unsuccessfully located (for example, in the joint area) or grow rapidly, which happens extremely rarely.

Lipomas are the most common mesenchymal tumors (mesenchymal tumors are soft tissue tumors and specific bone tumors). The incidence is about 2.1 per 1000 people per year, and men are diagnosed slightly more often than women.

Causes of lipomas

The exact causes of lipomas are unknown. Some researchers agree that genetic anomalies play a role in their formation. Another theory suggests a link between the occurrence of a lipoma and previous trauma. Risk factors for the development of lipomas can be obesity, alcohol abuse, liver disease, impaired glucose tolerance, hyperlipidemia. The appearance of a lipoma may be the result of another disease, for example, familial multiple lipomatosis.

Disease classification

Lipomas can be simple or multiple (multiple lipomatosis). The latter include Derkum’s disease, benign symmetrical lipomatosis (Madelung’s disease), familial lipomatosis, congenital infiltrating lipomatosis. Multiple lipomatosis accounts for approximately 5-10% of all detected cases of lipomas.

Depending on which tissue components are involved in the pathological process, fibrolipomas (with connective tissue elements), myolipomas (they contain muscle fibers), angiolipomas (include blood vessels), myxolipomas (contain mucous tissue), myelolipomas (contain hematopoietic tissues ).

Symptoms of lipoma

Lipomas in the subcutaneous adipose tissue feel soft and mobile, not soldered to the surrounding tissues. Lipomas are characterized by slow growth, and their size is usually from 1 to 10 cm. Larger lipomas are called “giant”. The lesions are usually painless unless they involve joints, nerves, or blood vessels. The skin over the lipoma is not changed.

In the gastrointestinal tract, lipomas are submucosal fatty tumors. They are asymptomatic, but can provoke ulceration and bleeding. Esophageal lipomas can make it difficult to swallow food and liquids, causing belching, vomiting, and reflux.

Lipomas of the small intestine are diagnosed, as a rule, in older people, most often located in the ileum and dangerous by blockage (obstruction) of the intestinal lumen.

In addition, intestinal lipomas cause pain, obstructive (mechanical) jaundice, and intussusception (invasion of one part of the intestine into another).

Extremely rarely, lipomas form in the heart: subendocardially – under the inner lining of the heart (endocardium) or intramurally – inside the muscle layer (myocardium). Usually, cardiac lipomas are not encapsulated and appear as a yellow mass protruding into the cavity of the heart. Cardiac lipomas can cause chest pain, arrhythmias, and shortness of breath.

Lipomas formed in the bronchi or lung parenchyma lead to impaired respiratory function.

Lipoma Diagnosis

Diagnosis requires a clinical examination by a physician and soft tissue ultrasound.

Ultrasound of soft tissues

Examination of soft tissues to detect pathological changes and diagnose neoplasms.

RUB 1,790

If the gastrointestinal tract is affected, contrast studies can be used, and in the case of an atypical location of the lipoma (for example, in the heart), in addition to ultrasound, computed or magnetic resonance imaging is performed.

Which doctors to contact

Diagnosis can be made by a dermatologist,
family doctor or
therapist. Surgical treatment is performed
surgeon.

Lipoma treatment

If the lipoma is painless and does not cause discomfort, no treatment is required. An indication for the removal of subcutaneous lipomas is their unfortunate location, that is, a cosmetic defect. The most effective method of correction is surgical excision of the lipoma together with the capsule.

In addition to excision for the treatment of small subcutaneous lipomas, there are conservative therapies, such as injections of lipolytic drugs, whose action is aimed at breaking down fat cells. However, after such treatment, relapses are possible.

Complications

Gastrointestinal lipomas can cause bleeding, blockage of the intestinal lumen, jaundice, and intussusception.

Cardiac lipomas can lead to embolism and cardiac arrhythmias.

Huge subcutaneous lipomas can compress nerves and surrounding structures. If a pedunculated lipoma occurs, there is a risk of its twisting, as a result of which the blood supply to the lipoma is disrupted, which is fraught with its necrosis or ulceration.

Prevention of lipoma

To prevent the occurrence of lipoma, factors that can provoke its growth should be minimized:

avoid injury to soft tissues,
maintain adequate weight,
treat disorders of carbohydrate metabolism,
monitor cholesterol levels and correct them in time.

Sources:

Charifa A, Azmat CE, Badri T. Lipoma Pathology. 2021 Sep 20. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021 Jan–. PMID: 29493968.
Kolb L, Yarrarapu SNS, Ameer MA, et al. Lipoma. [Updated 2021 Oct 2]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021 Jan-. Available from:
www.ncbi.nlm.nih.gov
Usoltsev D.M., Davidyan A.A., Babich R.A. Experience in the removal of giant lipomas in the conditions of an outpatient surgery center. Inpatient replacement technologies: outpatient surgery. – 2016. – No. 1-2 (61-62). – S. 94-96.

Hernia of the linea alba: operation and treatment

A hernia of the white line of the abdomen is the protrusion of the abdominal organs covered with the peritoneum through a defect in the middle part of the abdominal wall.

Why is it called that way? Along the midline of the abdomen, the tendons of the muscles that form the abdominal wall are closely intertwined. There are few vessels in this area and it is white on the section, which is why it was called that.

Usually the width of the hernia of the white line of the abdomen is 10-20 mm above the navel and 3-5 mm below the navel. However, in some people, its width sometimes reaches 100 mm or more. A hernial protrusion can appear both above the navel, which happens most often, or below it or near it, then it is called paraumbilical.

A hernia of the white line of the abdomen is somewhat more common in men aged 20–40 years, and in women after 40.

Symptoms of a hernia of the linea alba

In its appearance, predisposing and producing factors are distinguished.

The former include congenital or acquired defects in the structure of the connective tissue, which is the basis of muscle tendons, anatomical features of the structure of the abdominal wall, obesity, etc.

To the second – physiological (pregnancy) or pathological conditions leading to an increase in intra-abdominal pressure, as well as human working conditions (great physical exertion).

In its development, the disease goes through several stages. First, preperitoneal tissue comes out through a gap in the white line, gradually pushing the tendon fibers apart. Later, a full-fledged hernia is formed with a hernial sac, its contents and a hernial orifice, i.e. exit site for the hernia.

The symptomatology of the disease also depends on the stage of hernia formation. Initially, a person may only notice the appearance of a small tumor-like formation in the midline of the abdomen or near the navel, which does not cause discomfort and which disappears on its own when lying down. Later, a slight pain appears in this area during physical exertion or bending, and the formation itself increases in size.

As the hernial protrusion increases and various organs enter it, nausea, constant pain, and in some cases vomiting may appear.

Diagnosis of a hernia of the linea alba

Diagnosis of a hernia of the white line of the abdomen in most cases is not difficult and a simple examination of the patient is sufficient. But sometimes additional tests, such as ultrasound, computed tomography (CT), or magnetic nuclear imaging (MRI), may be needed.

As with any surgery, a laboratory test, ECG, chest X-ray and examination by a therapist are required.

Treatment of hernia of the linea alba

The operation consists in removing the hernial sac (if it is large), repositioning its contents into the abdominal cavity and closing the defect of the abdominal wall.

There are two main methods for eliminating a defect – with one’s own tissues (stretch operations) or using synthetic meshes (prosthetics).

According to the recommendations of the European and Russian Societies of Herniology, preference is given to prosthetic surgeries, since the frequency of relapses after such surgeries is several times lower. The latter can be performed both openly and laparoscopically. Long-term results of their treatment are comparable.

Operations are performed under various types of anesthesia: local anesthesia, spinal, general.